Effects of nutritional guidance on frailty in older adults: A systematic review.

BACKGROUND

Frailty is a prevalent geriatric syndrome associated with risk of disability, hospitalization, and mortality. Despite nutrition and exercise playing central roles in maintaining muscle mass and function, the specific effects of nutritional guidance, distinct from supplementation, remain unclear.

OBJECTIVE

This systematic review aimed to evaluate the effectiveness of nutritional guidance interventions on frailty in community-dwelling older adults.

METHODS

A systematic search in MEDLINE (PubMed) identified relevant randomized controlled trials (RCTs) published up to April 2025. Eligible studies included those with participants aged ≥65 years who received nutritional guidance, defined as dietary counseling or education without supplementation, with frailty status as the primary outcome measure. The risk of bias was assessed using Cochrane RoB 2.0.

RESULTS

From 211 initial records, 11 relevant RCTs were included in the analyses. The interventions varied in duration (12 weeks to 8 years), delivery (individual or group sessions), and implementers (dietitians, health professionals, or non-professionals). Short-term interventions produced mixed results, whereas long-term programs, particularly those combined with exercise, showed more consistent improvements in frailty measures. Individually tailored and professionally delivered interventions were generally more effective. However, substantial heterogeneity in intervention design, frailty definitions, and outcome measures limited comparability across studies. Few trials quantitatively assessed dietary intake, restricting mechanistic understanding.

CONCLUSION

Nutritional guidance can help prevent or improve frailty in older adults, especially when implemented as a long-term, individualized, and professionally delivered program, ideally combined with physical activity. Future research should adopt standardized frailty criteria, reliable dietary assessment methods, and multidisciplinary approaches to strengthen the evidence and inform sustainable strategies for healthy aging.